Higher intensity and patient engagement in the postacute rehabilitation setting is achievable, resulting in better functional outcomes for older adults, say authors of an article published online in Journal of the American Medical Directors Association.

Twenty-six older adults admitted from a hospital for postacute rehabilitation in a skilled nursing facility in St Louis, Missouri, participated in a randomized controlled trial of enhanced medical rehabilitation versus standard-of-care rehabilitation. Based on models of motivation and behavior change, enhanced medical rehabilitation is a set of behavioral skills for physical therapists and occupational therapists that increase patient engagement and intensity, with the goal of improving functional outcomes through a patient-directed, interactive approach; increased rehabilitation intensity; and frequent feedback to patients on their effort and progress.

The authors assessed therapy intensity using the time that the patient was active in therapy sessions. Therapy engagement was assessed using the Rehabilitation Participation Scale. Functional and performance outcomes were measured using Barthel Index, gait speed, and 6-minute walk.

Participants randomized to enhanced medical rehabilitation had higher intensity therapy and were more engaged in their rehabilitation sessions. They had more improvement in gait speed (improving from 0.08 to 0.38 m/s versus 0.08 to 0.22 m/s in standard of care) and 6-minute walk (from 73 to 266 feet versus 40 to 94 feet in standard of care), with a trend for better improvement of Barthel Index (+43 points versus +26 points in standard of care), compared with participants randomized to standard-of-care rehabilitation.